Case Study Number 2
What is the significance of each of D.W.’s laboratory findings? The tests that were run for the patient D.W. were performed to determine a diagnosis and treatment. Even though the disease systemic lupus erthematosus (SLE) doesn’t have a test that specifically diagnosis this diseases, there are test that are run to help with understand contributing factors. The significance of a positive antinuclear antibody (ANA) titer is that 98% of people with systemic lupus test positive, even though it is not enough for a diagnosis of lupus (healthy individuals can test positive) it is a good indication along with other diagnostics test in the presence of lupus. The anti-double-stranded DNA antibody (anti-dsDNA) is a specific type of ANA antibody found in about 30% of people with systemic lupus. Less than 1% of healthy individuals have this antibody, making it helpful in confirming a diagnosis of systemic lupus. A positive value is also indicative of more serious lupus. Anti-smooth muscle antibody is a blood test that detects the presence of antibodies against smooth muscle. This test can help distinguish between lupus and autoimmune hepatitis. C-reactive protein (CRP) is a protein produced by the liver, and high levels of CRP in your blood may mean you have inflammation due to lupus. ESR also tests for inflammation. It measures the amount of a protein that makes the red blood cells clump together (Lupus foundation of America). C3 and C4 test are low due to, Complement proteins are used up by the inflammation caused by lupus, which is why people with inflammation due to active lupus often have low complement levels (Lupus foundation of America). Given that most tests are nonspecific, how is SLE diagnosed?
Systemic lupus erythematosus is a disease that is not easily diagnosed. Many laboratory tests must be done to determine if a patient is has SLE. Due to SLE mimicking many other diseases, as well as affecting many systems in the body a full head to toe assessment needs to be done on the patient at every checkup should occur every 6months after diagnosis. According to the American College of Rheumatology there are 11 common criteria in the diagnosis of lupus. Having four or more of the criteria is a good indication of lupus along with lab values. A malar rash over the cheeks or face in the shape of a butterfly, discoid rash (red, raised disk shaped patches), photosensitivity, oral ulcers, arthritis, serositis/pericarditis/pleuritis, kidney disorder (persistent protein or cellular casts in urine), neurologic disorder (seizure or psychosis), blood disorder (anemia, leukopenia, lymphopenia, thrombocytopenia), abnormal ANA, or abnormal anti-double-stranded DNA or anti-Sm, positive antiphospholipid antibodies. Other possible symptoms or indications can include fever, fatigue, hair loss, and fingers turning white or blue when cold. What priority problems need to be addressed with D.W.?
At this point in her disease process the most important problem that needs to be addressed is slowing down her disease and limiting flare ups. One key to managing lupus is to understand the disease and its impact. Learning to recognize the warning signs of a flare can help the patient take steps to ward it off or reduce its intensity. Many people with lupus experience increased fatigue, pain, a rash, fever, abdominal discomfort, headache, or dizziness just before a flare (Lupus, a patient care guide). Developing strategies to prevent flares can also be helpful, such as learning to recognize her warning signals and maintaining good communication with her health care team. It is also important that she receives regular health care, instead of seeking help only when symptoms worsen. Results from a medical exam and laboratory work on a regular basis allows the doctor to note any changes and to identify and treat flares early. If new symptoms are identified early, treatments may be more effective. Providing guidance...
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